HOUSE Amended 2nd Reading March 25, 2004Second Regular Session Sixty-fourth General Assembly STATE OF COLORADO ENGROSSED This Version Includes All Amendments Adopted on Second Reading in the House of Introduction LLS NO. 04-0369.01 Kristen Forrestal HOUSE BILL 04-1014 HOUSE SPONSORSHIP Tochtrop, SENATE SPONSORSHIP Isgar, House Committees Senate Committees Health, Environment, Welfare, & Institutions Finance Appropriations A BILL FOR AN ACT Concerning the regulation of medication administration by certified nurse aides, and making an appropriation in connection therewith. Bill Summary (Note: This summary applies to this bill as introduced and does not necessarily reflect any amendments that may be subsequently adopted.) Requires a certified nurse aide to meet specific prerequisites prior to obtaining training as a medication aide to administer medications in nursing facilities. Requires that the training to become a medication aide include classroom training, skills demonstration, and clinical experience. Requires specific topics to be included in the training classes. Limits the tasks that a medication aide may perform after completing a training program. Requires the state board of nursing (board) to promulgate rules regarding medication aides. Grants authority to the board to approve medication aide training and education programs. Repeals the training, education, and functions of medication aides, effective July 1, 2009. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. Part 1 of article 38.1 of title 12, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SECTION to read: 12-38.1-110.5. Pilot program - medication aides - training - scope of duties - repeal. (1) The board shall establish a pilot program for the purpose of training certified nurse aides to become medication aides and to administer medications in nursing facilities. The pilot program shall have a maximum of two hundred fifty certified nurse aide participants and five training programs. Costs associated with the pilot program shall be paid for by the nurse aide certification application fee collected pursuant to section 12-38.1-104 and the certified nurse aide renewal fee collected pursuant to section 12-38.1-109. (2) Prior to a certified nurse aide obtaining training as a medication aide to administer medications in a nursing facility, the certified nurse aide shall meet the following prerequisites: (a) Possession of a high school diploma or a general equivalency diploma; (b) Attainment of the age of eighteen years; (c) The ability to read and comprehend English; (d) At least one thousand hours working as a certified nurse aide in the same nursing facility; and (e) Letters of recommendation from a director of nursing and two charge nurses. (3) (a) A certified nurse aide who has met the prerequisites of subsection (1) of this section may train to become a medication aide to administer medications in a nursing facility. Such training shall include one hundred forty hours of training that includes eighty hours of classroom training, fifteen hours of return skills demonstration, and fifteen hours of clinical experience. (b) A training class shall include the following topics: (I) Fundamentals of the gastrointestinal, musculoskeletal, skin and sensory, urinary, cardiovascular, respiratory, endocrine, reproductive, and nervous systems and the medications affecting each system; (II) Psychotherapeutic medications; (III) Inflammation, infection, immunity, and malignant disease; (IV) Pain management; (V) Basic principles of administering medications and infection control; (VI) Documentation of medication administration; (VII) Patients' rights and ability to refuse medication; (VIII) Behavioral intervention; and (IX) Positions of patients in preparation for medication administration. (c) A medication aide applicant shall be required to pass an examination approved by the director of the division of registrations relating to the knowledge, skills, and judgments as incorporated into the approved educational programs. (d) The division of registrations shall hold at least two examinations annually for medication aides at such places and at such times as determined by the division. The director of the division of registrations may contract with a vendor to develop or administer the examinations. (4) (a) A certified nurse aide who has completed a board-approved medication aide training program may perform the following tasks, in a nursing facility only: (I) Measurement and documentation of vital signs prior to administering medications; (II) Administration of routinely prescribed oral medications, which the medication aide has personally prepared, including the crushing and administering of medications if such preparation is appropriate according to the manufacturer's instructions and a physician's order, and excluding coumadin and its derivatives and any scheduled drugs; and (III) Documentation of any medications personally administered by the medication aide. (b) A medication aide shall report medication administration errors to his or her supervisor. (5) (a) The board shall promulgate rules regarding the supervision requirements for a medication aide, the requirements for a registered nurse to do a patient assessment prior to a medication aide administering medications, and requirements for a registered nurse to review medications to be administered by a medication aide. (b) The board shall approve the medication aide training programs in the same manner as the nurse aide training programs pursuant to section 12-38.1-108 (1) and (5). (c) If the board determines that an applicant for a certificate to practice as a medication aide does not possess the qualifications specified in this section, or if the board determines that there is reasonable cause to believe that the applicant has committed any of the acts set forth in section 12-38.1-111, the board may deny the applicant a certificate as grounds for discipline. The provisions of section 12-38.1-112 shall apply to any such action. (6) The administration of medications by medication aides shall not alter requirements and limitations on the delegation of nursing tasks pursuant to section 12-38-132. (7) (a) This section is repealed, effective July 1, 2009. (b) Prior to such repeal, the training, education, and functions of medication aides shall be reviewed as provided for in section 24-34-104, C.R.S. SECTION 2. 12-38.1-111 (1), Colorado Revised Statutes, is amended BY THE ADDITION OF THE FOLLOWING NEW PARAGRAPHS, to read: 12-38.1-111. Grounds for discipline. (1) The board may suspend, revoke, or deny any certification to practice as a nurse aide upon proof that such person: (p) Has willfully or negligently acted in a manner inconsistent with the health or safety of persons under his or her care; (q) Has falsified or in a negligent manner made incorrect entries or failed to make essential entries on patient records. SECTION 3. 12-38.1-111, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SUBSECTION to read: 12-38.1-111. Grounds for discipline. (4) An employer of a medication aide shall report conduct that constitutes grounds for discipline pursuant to this section to the board and any disciplinary action taken by the employer against a medication aide or the resignation of a medication aide in lieu of a disciplinary action resulting from such conduct. SECTION 4. 24-34-104 (40), Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW PARAGRAPH to read: 24-34-104. General assembly review of regulatory agencies and functions for termination, continuation, or reestablishment. (40) The following agencies, functions, or both, shall terminate on July 1, 2009: (j) The training, education, and functions of medication aides pursuant to section 12-38.1-110.5, C.R.S. SECTION 5. Appropriation. (1) In addition to any other appropriation, there is hereby appropriated, out of any moneys in the division of registrations cash fund created pursuant to section 24-34-105, Colorado Revised Statutes, not otherwise appropriated, to the department of regulatory agencies, for the fiscal year beginning July 1, 2004, the sum of eighty-seven thousand one hundred twenty-five dollars ($87,125). (2) In addition to any other appropriation, there is hereby appropriated to the department of law, for the fiscal year beginning July 1, 2004, the sum of seven hundred twenty-nine dollars ($729), or so much thereof as may be necessary, for the provision of legal services to the department of regulatory agencies related to the implementation of this act. Said sum shall be from cash funds exempt received from the department of regulatory agencies out of the appropriation made in subsection (1) of this section. SECTION 6. Effective date. This act shall take effect at 12:01 a.m. on the day following the expiration of the ninety-day period after final adjournment of the general assembly that is allowed for submitting a referendum petition pursuant to article V, section 1 (3) of the state constitution (August 4, 2004, if adjournment sine die is on May 5, 2004); except that, if a referendum petition is filed against this act or an item, section, or part of this act within such period, then the act, item, section, or part, if approved by the people, shall take effect on the date of the official declaration of the vote thereon by proclamation of the governor.